Cardiovascular Drugs (Antihypertensive)

labetalol

adrenergic receptors blocker that block s alpha 1, alpha 2, AND beta 2 receptors, which can be used in the treatment of gestational hypertension

less than 120 and less than 80

normal blood pressure levels

120-129 or less than 80

elevated blood pressure levels

130-139 or 80-89

stage 1 hypertension blood pressure levels

greater than 140 or greater than 90

stage 2 hypertension blood pressure levels

Hypertension

condition where systolic blood pressure exceeds 130 mmHg or diastolic blood pressure exceeds 80 mmHg on at least two occasions. It results from increased arteriolar resistance. It is often idiopathic, but can also occur secondary to other diseases. Increases in likelihood with age.

30%

Hypertension affects what percent of adults in the United States?

90%

what percent of patients have essential hypertension which has no identifiable cause

heart disease and stroke

Chronic hypertension can lead to these two conditions

chronic kidney disease and heart failure

chronic hypertension is a risk factor for these two conditions

Diabetes, obesity, disability

three conditions that increase the likelihood of hypertension

Stress, high sodium intake, smoking

three environmental factors that increase the likelihood of hypertension.

cardiac output and peripheral vascular resistance

Arterial blood pressure is directly proportional to these two values, therefor many antihypertensive drugs lower blood pressure by reducing these values.

Baroreflexes

a homeostatic reflex where a fall in blood pressure causes baroreceptors to send fewer impulses to the cardiovascular centers in the spinal cord. This causes increase sympathetic and decreased parasympathetic activity resulting in increased vasoconstriction and cardiac output and therefor a rise in blood pressure.

Baroreceptors

pressure sensitive neurons found in the aortic arch and carotid sinuses. Increase in their activity decreases blood pressure, whereas decrease in their activity raises it. In the kidney they produce renin in response to low blood pressure to trigger the renin-angiotensin-aldosterone system.

Renin-angiotensin-aldosterone system

hormonal system employed by the kidney to increase blood pressure in response to reduced arterial pressure, low sodium intake, or high sodium release.

Renin

hormone released by baroreceptors in the kidney in response to reduced arterial pressure, low sodium intake, or high sodium release. Functions in converting angiotensinogen to angiotensin I

Angiotensin II

a potent circulating vasoconstrictor derived from angiotensin I. Constricts both arterioles and veins to increase blood pressure. Exerts a preferential vasoconstrictor action on the efferent arterioles of the renal glomerulus increasing glomerular filtration.

AT1

receptor that mediates the effects of angiotensin II. Blocked by ARBs in the treatment of hypertension

Aldosterone

hormone whose release is stimulated by angiotensin II. Functions in increasing increased blood volume which further increases blood pressure.

reduce cardiovascular and renal morbidity and mortality

The goal in the treatment of hypertension is to

Less than 130 and less than 80

the goal blood pressure level in the treatment of hypertension

thiazide diuretic

ACE inhibitor

ARB

calcium channel blocker

four drug classes suggested in the initiation of hypertension treatment.

20, 10

If diastolic blood pressure is greater than ____ mm Hg or if diastolic blood pressure if greater than ___ mm Hg above the goal, the patient should be started on two drug simultaneously.

beta blockers

which class of antihypertensive drugs should not be given to diabetics due to risk of hyperglycemia and blunted response to insulin.

Diuretics

antihypertensive drugs that function by decreasing blood volume leading to decreased blood pressure. Electrolyte monitoring should be performed periodically.

Thiazide diuretics

diuretics that lower blood pressure initially by increase sodium and water excretion. Decrease in extracellular volume results in a decrease in cardiac output and renal blood flow. Used as an initial treatment for hypertension and are effective in combination. Should not be used in patients with decrease kidney function. Ie) hydrochlorothiazide, chlorothiazide

Hypokalemia, hyperuricemia, hyperglycemia

three major side effects of thiazide diuretics

Loop diuretics

diuretics that act by blocking sodium and chloride reabsorption in the kidneys. They decrease renal vascular resistance and increase renal blood flow to prevent release of renin. Rarely used alone, usually in combination. Commonly used to manage symptoms of heart failure and edema. Ie) furosemide

Hypokalemia

kidney stones

two major side effect of loop diuretics

Potassium sparing diuretics

diuretics that are often used in combination with loop or thiazide diuretics to reduce the amount of potassium lost in the urine. Ie) triamterene, spironolactone

late distal and collecting ducts

Triamterene potassium sparing diuretic prevents sodium reuptake by blocking sodium transport at the _______ of the kidney

Aldosterone receptor

Spironolactone potassium sparing diuretic blocks this receptor to prevent sodium reuptake.

furosemide

name a loop diuretic used in the treatment of hypertension

Furosemide

Hydrochlorothiazide

Chlorothiazide

Triamterene

Spironolactone

(Fantastic Hearts Can Tinkle Sodium)

name five diuretics used in the treatment of hypertension.

Triamterene

Spironolactone

name two potassium sparing diuretics used in the treatment of hypertension.

Hydrochlorothiazide

Chlorothiazide

name two thiazide diuretics used in the treatment of hypertension

hyperkalemia

major side effect of potassium sparing diuretics

beta blockers

antihypertensive medications that are a treatment option for hypertensive patients with concomitant heart disease or failure. Reduce blood pressure by decreasing cardiac output, decreasing sympathetic outflow, and inhibiting the release of renin. Ie) propranolol, metoprolol, atenolol

decrese CO

decrese sympathetic outflow

inhibit release of renin

three mechanisms by which beta blockers treat hypertension

asthma

Propranolol and other antihypertensive medications that are non-selective beta blockers should not be administer to patients having...

Plaque formation

dangerous side effect of non-selective beta blockers due to the fact that they disturb lipid metabolism and increases triglyceride levels in the blood.

timolol

propranolol

atenolol

metroprolol

esmolol

betaxolol

(Today PAM Exercised Briskly)

name six beta blockers used in the treatment of hypertension

atenolol

metroprolol

esmolol

betaxolol

name four beta 1 selective beta blockers used in the treatment of hypertension

timolol

propranolol

name two nonselective beta blockers used in the treatment of hypertension

two weeks

how long can it take for beta blockers to develop their full effects in the treatment of hypertension?

heart block

peripheral vascular disease

diabetes

name three contraindictations of beta blockers

Ace inhibitors

antihypertensive medications used as first line treatment in patients with high coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease. Lower blood pressure by inhibiting the conversion of angiotensin I to angiotensin II as well as preventing the breakdown of bradykinin. Ie) captopril, enalapril, lisinopril

cardiac output, heart rate, or contractility

Ace inhibitors are useful in patients having other underlying disease because they reduce peripheral vascular resistance without increasing these three variables

ACE

enzyme which cleaves angiotensin I to form angiotensin II. Also responsible for the breakdown of bradykinin. Is blocked by inhibitors to decrease vasoconstriction and therefor lower blood pressure.

Bradykinin –

peptide that increases the production of nitric oxide and prostacyclin two potent vasodilators. It is broken down by ACE. Inhibitors of ACE allow for this peptide to accumulate in blood vessels, resulting in increased vasodilation and lowering of blood pressure.

Preload

the force that stretched the cardiac muscle prior to contraction. Decreased by ACE inhibitors

Afterload

the force exerted during ventricular ejection. Decreased by ACE inhibitors

Lisinopril

captopril

enalapril

(Light Cardio Everyday)

name three ace inhibitors used in the treatment of hypertension

dry cough and altered taste

two major side effects of ace inhibitors

Calcium channel blockers

antihypertensive drugs that are useful in hypertensive patients with diabetes or stable ischemic heart disease. Function by preventing contraction of blood vessels via blocking of L type calcium channels in the cardiac and vascular smooth muscle cells. Should not being given in high doses due to increased risk of myocardial infarction due to excessive vasodilation and reflex cardiac stimulation

L type calcium channels

channels found in vascular smooth muscle and in the heart, which are blocked by calcium channel blockers.

Diphenylalkylamines

class of calcium channel blockers that has significant effects on both cardiac and vascular smooth muscle cells. It is also used in the treatment of angina, supraventricular tachyarrhythmias, and prevention of migraines or cluster headaches. Ie) Verapamil

Benzothiazepines

class of calcium channel blockers that has effects on both cardiac and vascular smooth muscle cells. Has a less pronounced negative inotropic (reduces force of contraction) effect on the heart than verapamil. Ie) Diltiazem

Dihydropyridines

class of calcium channel blockers that have a much greater affinity for vascular smooth muscle cells than cardiac muscle cells. Show little interaction with other cardiovascular drugs.

Nicardipine

Clevidipine

Nifidipine

Verapamil

Diltiazam

name five calcium channel blockers used in the treatment of hypertension

Nicardipine

Clevidipine

name two calcium channel blockers than are used in hypertensive emergency

myocardial infarcion

high doses of calcium channel blockers can cause...

Alpha adrenoreceptor blocking agents

antihypertensive drugs that work by blocking alpha1 adrenoreceptors. Decrease peripheral vascular resistance by relaxing arterial and venous smooth muscle. Only used for refractory cases due to high risk of side effects. Can be used in the treatment of benign prostatic hyperplasia. Ie) prazosin, terazosin

Alpha beta adrenoreceptor agents

antihypertensive drugs that block alpha 1, beta 1, and beta 2 receptors. Ie) labetalol, carvedilol

prazosin

terazosin

phentolamine

labetalol

carvedilol

(Per The Physician, Limit Coffee)

name five adrenergic receptor blockers used in the treatment of hypertension

phentolamine

name one adrenergic receptor blocker that blocks both alpha 1 and alpha 2 and is commonly used in hypertensive emergency

labetalol

carvedilol

name two adrenergic receptors blockers that block alpha 1, alpha 2, AND beta 2 receptors.

prazosin

terazosin

name two adrenergic receptor blockers that act selectively on alpha 1 receptors.

refractory hypertension

due to the many side effects that they cause, alpha 1 selective adrenergic blockers are only used for...

Centrally acting adrenergic drugs

antihypertensive drugs that act centrally as an alpha 2 agonist to produce inhibition of sympathetic vasomotor centers. Used primarily in the treatment of hypertension which has not responded to two or more drugs. Ie) clonidine, methyldopa

Vasodilators

antihypertensive drugs that are direct acting smooth muscle relaxants that act by producing relaxation of vascular smooth muscles primarily in arteries and arterioles. Decreases peripheral resistance to reduce blood pressure. Also increase plasma renin concentration resulting in water retention which can be addressed with a diuretic. Ie) hydralazine, minoxidil

hydralazine

nitroglycerin

minoxidil

(Help Narrowed Muscles)

name three vasodilators used in the treatment of hypertension

hydralazine

which vasodilator can be used in gestational hypertension

nitroglycerin

which vasodilator is used in hypertensive emergency

water retention and reflex tachycardia

two major side effects of vasodilators. Can be addressed with a diuretic and beta blocker respectively.

clonidine

methyldopa

losartan

valsartanterm

aliskeren

(Careful Monitoring Limits Vascular Emergency)

name two centrally acting, two A1 receptor blockers, and a renin inhibitor used in the treatment of hypertension

clonidine

methyldopa

name two centrally acting drugs used in the treatment of hypertension

methyldopa

drug that is Converted to methyl norepinephrine centrally and acts on alpha 2 to inhibit sympathetic vasomotor centers. Decreases peripheral resistance to lower BP

methyldopa

a centrally acting antihypertensive drug that can be used during pregnancy

clonidine

drug which Acts as alpha 2 agonist to inhibit sympathetic vasomotor centers. Decreases peripheral resistance to lower BP

oral

transdermal patch

two forms of administration for clonidine

losartan

valsartan

name two A1 receptor blockers used in the treatment of hypertension

hyperkalemia

a major side effect of A1 receptor blockers

ace inhibitor used

pregnancy

name two contraindications of A1 receptor blockers

aliskeren

name a renin inhibitor used in the treatment of hypertension

ace inhibitor used

arb used

pregnancy

name three contraindictions of renin inhibitors

Hypertensive emergency

a life threatening severe elevation in blood pressure characterized by a systolic pressure greater than 180 or diastolic greater than 120 with evidence of organ damage. Treatment is directed by the type of target organ damage or comorbidities present.

calcium channel blockers

nitric oxide vasodilators

adrenergic receptor blockers

three drug classes used in hypertensive emergency

Resistant hypertension

blood pressure that remains elevated despite administration of an optimal three drug regimen that includes a diuretic. Common causes include poor compliance, excessive alcohol consumption, concomitant conditions or medications, and poor treatment.